i will blow up the image first 2 differentials - hemopneumothorax - hydropneumothorax Hemopnumothorax - both the hemo and pneumo components could be from the same cause ex - stab injury or any other traumatic injury to chest ex - motor vehicle accident, heavy object falling on chest, as in earthquake - but since i don't see any broken ribs, i go for stag injury as a possible mechanism. Hydropneumothorax - the hydro and pneumo components could be from connected or totally unrelated causes. ex - the hydro component could be because of tuberculosis effusion or cirrhosis-associated hydrothorax (yes, u can have a large one) and the thoracentecis for draining the fluid could have inadvertently damaged the pleura. A tuberculous cavity could have ruptured due to repeated coughing and led to this picture. or the patient could have blebs sec to COPD, which could have ruptured and given rise to the pneumo part, independent of the hydro part.
Thanks my friend Neo Star, thank you again for the great explain, and I'm happy finally this time I can figure the right answer myself in certain degree :-D
